Evaluation of the Improving Child Welfare Outcome through Systems of Care Grant Program - Collaborative Membership Form

Improving Child Welfare Outcomes through Systems of Care

Documents and Forms

Document Name Document Type
Appendix O IC17 - Collaborative Membership Form.doc Other-survey

Information Collection (IC) Details

IC Title:	Evaluation of the Improving Child Welfare Outcome through Systems of Care Grant Program - Collaborative Membership Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey			Appendix O IC17 - Collaborative Membership Form.doc		No	No	Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.